How to optimise anticoagulation for patients who are obese

2020 ◽  
Vol 81 (1) ◽  
pp. 1-8
Author(s):  
Haseem Raja ◽  
Jecko Thachil
Keyword(s):  
Health Care ◽  
At Risk ◽  
Health Care Professionals ◽  
Number Of Patients ◽  
Hospital Acquired

Management of anticoagulation has become a hot topic in the last decade. Health-care professionals are encountering increasing number of patients diagnosed with a thromboembolic episode, probably as a result of heightened awareness. In addition, the recognition that hospital-acquired thrombosis causes substantial mortality has led to an emphasis on appropriate thromboprophylaxis in all patients deemed at risk of thrombosis. However, the use of anticoagulants for both treatment and prophylaxis of thrombosis can pose a challenge in individuals who are obese. There are no detailed studies in this area and as such the dosing and monitoring of anticoagulants in these individuals can be problematic.

scholarly journals Curricular Development and Implementation of a Longitudinal Integrative Medicine Education Experience for Trainees and Health-Care Professionals at an Academic Medical Center

2019 ◽  
Vol 8 ◽  
pp. 216495611983748 ◽  
Author(s):  
Susanne M Cutshall ◽  
Tejinder K Khalsa ◽  
Tony Y Chon ◽  
Sairey M Vitek ◽  
Stephanie D Clark ◽  
...  
Keyword(s):  
Health Care ◽  
Integrative Medicine ◽  
Health Care Professionals ◽  
Medical Center ◽  
Academic Medical Center ◽  
Curricular Development ◽  
Medical Needs ◽  
Academic Medical ◽  
Number Of Patients ◽  
Prevention And Health Promotion

A growing number of patients and consumers are seeking integrative medicine (IM) approaches as a result of increasing complex medical needs and a greater emphasis on prevention and health promotion. Health-care professionals need to have knowledge of the evidence-based IM resources that are safe and available to patients. Medical institutions have acknowledged the need for education and training in various IM modalities and whole-health approaches in medical curricula. There is a strong need to develop and incorporate well-structured IM curricula across all levels of learning and practice within medicine. This article provides an example of the development, implementation, impact, and assessment of IM education curricula across all learner levels at a large academic medical center.

scholarly journals Collateral damages in the SARS-CoV-2 pandemia– two cases

2020 ◽  
Vol 2 (1) ◽  
Author(s):  
Christian Urbanek ◽  
Jana Kötteritzsch ◽  
Wolfgang Zink ◽  
Armin J. Grau
Keyword(s):  
Health Care ◽  
Intensive Care ◽  
Brain Edema ◽  
Health Care Professionals ◽  
Tertiary Care ◽  
Delayed Diagnosis ◽  
Care Physician ◽  
Prolonged Treatment ◽  
Care Hospital ◽  
Number Of Patients

Abstract Background and aims At present, “severe acute respiratory syndrome new coronavirus” (SARS-CoV-2) affects the whole world and has led to a pandemia with almost 2.000.000 infected patients in the mid of April 2020 (WHO). Thus, health care specialists primarily focus on therapy of corona disease 2019 (COVID-19) and a lot of effort has been undertaken to get more manpower on intensive care units. However, the number of patients with life threatening diseases other than COVID-19 like heart attacks or strokes has not changed at all. With a strong focus on COVID-19, there is a marked risk of diagnostic and therapeutic delays or misdiagnoses, potentially harming those patients. In this respect, we present two of those cases with the intent to improve the medical management of “traditional“ diseases in times of corona pandemia. Methods We present two patients with diseases others than SARS-CoV-2. Both cases were treated in our institution, a tertiary care hospital in the Southwest of Germany. Results One patient had a prolonged treatment on intensive care unit (ICU) because of heart failure following voluntary isolation because of fearing COVID-19 and subsequent shortage of medication. Another patient with hypothesis of COVID-19 of primary care physician because of fever and a history of skiing in a high risk region for SARS-CoV-2 was sent home for isolation. After disease progression, the patient presented in an external hospital with fever, pain in the right ear and tachypnea. Immediately, antibiotics were started at same day, but nevertheless, he developed a septic shock, leading to multi organ failure. In blood samples, bacteria Streptococcus pyogenes was found, without any signs of SARS-CoV-2-infection. Despite adequate antibiosis, the patient developed fixed pupils, brain edema and died because of massive brain edema. Conclusion Focusing only on COVID-19 may lead to delayed diagnosis and therapy in patients with “traditional diseases”. These two cases impressively clarify medical challenges in times of SARS-CoV-2 pandemia. It is important to emphasize that physicians and health care professionals have not only to focus on COVID-19 and virus associated diseases, but also on adequate drug supply, intake and monitoring and differential diagnoses, respectively.

Working with Nonheterosexual Youth to Understand Sexual Identity Development, At-Risk Behaviors, and Implications for Health Care Professionals

2005 ◽  
Vol 96 (3) ◽  
pp. 651-654 ◽  
Author(s):  
Shannon D. Smith ◽  
Shannon B. Dermer ◽  
Randall L. Astramovich
Keyword(s):  
Health Care ◽  
At Risk ◽  
Identity Development ◽  
Sexual Development ◽  
Health Care Professionals ◽  
Behavioral Outcomes ◽  
Sexual Identity Development ◽  
Major Health ◽  
Homosexual Orientation ◽  
Age Range

This article outlines special issues related to being a nonheterosexual youth. Information is presented on the sexual development of homosexual youth and their unique challenges. Included are data about the average age of initial awareness and self-identification of gay, lesbian, bisexual, transgendered, and questioning youth. The average age of awareness of homosexual orientation is between 10 or 11 years, while the average for identifying or self-labeling is ages 13–15. This age range is consistent across studies. The special issues related to a unique sexual development, prejudices associated with being a nonheterosexually oriented youth, typical behavioral outcomes of dealing with discrimination, and major health concerns for this at-risk population are identified. Finally, implications for health care professionals working with these adolescents are outlined.

scholarly journals Attitude of health care professional students towards hand hygiene

2019 ◽  
Vol 6 (9) ◽  
pp. 3969
Author(s):  
Rintu Jayan ◽  
Riya Paul ◽  
Riyamol Abraham ◽  
Riyamol Roy ◽  
Roniya Dominic ◽  
...  
Keyword(s):  
Health Care ◽  
Hand Hygiene ◽  
Health Care Professionals ◽  
Attitude Scale ◽  
Research Approach ◽  
Entire Study ◽  
Professional Students ◽  
Hospital Acquired Infections ◽  
Study Results ◽  
Hospital Acquired

Background: Hands are the principal route of nosocomial infections or hospital acquired infections or health associated infections. Hand hygiene is effective in reducing infection rates. Hand hygiene among the health care professionals play a pivotal role in preventing the transmission of hospital acquired infections. The aim of the study was to assess the attitude regarding hand hygiene among students of healthcare professions.Methods: Quantitative research approach and descriptive survey design were used for the study. The purposive sampling technique was adopted to select 100 samples, 25 each from MBBS, BDS, B.Sc. Nursing and BPT. A structured attitude scale was used to collect the data. The collected data was analyzed using descriptive and inferential statistics.Results: The study results showed that majorities (55%) of sample were in the age of 22 years, majorities (90%) were females, and majority (98%) of sample had previous information regarding hand hygiene. The entire study sample had favorable attitudes towards hand hygiene. The study showed a significant association between attitude scores and receiving previous information on hand hygiene.Conclusions: The study concluded that health professional students have favorable attitude towards hand hygiene. 

Are Health Care Professionals Advising Patients With Diabetes or At Risk for Developing Diabetes to Exercise More?

Diabetes Care ◽  
2006 ◽  
Vol 29 (3) ◽  
pp. 543-548 ◽  
Author(s):  
E. H. Morrato ◽  
J. O. Hill ◽  
H. R. Wyatt ◽  
V. Ghushchyan ◽  
P. W. Sullivan
Keyword(s):  
Health Care ◽  
At Risk ◽  
Health Care Professionals ◽  
Patients With Diabetes

scholarly journals Pulmonary Rehabilitation in Canada: A Report from the Canadian Thoracic Society COPD Clinical Assembly

2015 ◽  
Vol 22 (3) ◽  
pp. 147-152 ◽  
Author(s):  
Pat G Camp ◽  
Paul Hernandez ◽  
Jean Bourbeau ◽  
Ashley Kirkham ◽  
Richard Debigare ◽  
...  
Keyword(s):  
Health Care ◽  
Lung Disease ◽  
Present Article ◽  
Health Care Professionals ◽  
Pulmonary Rehabilitation ◽  
Online Survey ◽  
Program Improvement ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Number Of Patients

BACKGROUND: Pulmonary rehabilitation (PR) is a recommended intervention in the management of individuals with chronic lung disease. It is important to study the characteristics and capacity of programs in Canada to confirm best practices and identify future areas of program improvement and research.OBJECTIVE: To identify all Canadian PR programs, regardless of setting, and to comprehensively describe all aspects of PR program delivery. The present article reports the results of the survey related to type of program, capacity and program characteristics.METHODS: All hospitals in Canada were contacted to identify PR programs. A representative from each program completed a 175-item online survey encompassing 16 domains, 10 of which are reported in the present article.RESULTS: A total of 155 facilities in Canada offered PR, of which 129 returned surveys (83% response rate). PR programs were located in all provinces, but none in the three territories. Most (60%) programs were located in hospital settings, 24% were in public health units and 8% in recreation centres. The national capacity of programs was estimated to be 10,280 patients per year, resulting in 0.4% of all Canadians with chronic obstructive pulmonary disease (COPD) and 0.8% of Canadians with moderate to severe COPD having access to PR. COPD, interstitial lung disease, and asthma were the most common diagnoses of patients. The majority of programs had at least four health care professionals involved; 9% had only one health care professional involved.CONCLUSION: The present comprehensive survey of PR in Canada reports an increase in the number of programs and the total number of patients enrolled since the previous survey in 2005. However, PR capacity has not kept pace with demand, with only 0.4% of Canadians with COPD having access.

Evidence-Based Clinical Guidelines and Their Impact on Prevention of Catheter-Related Bloodstream Infections

2012 ◽  
Vol 5 (1) ◽  
pp. 18-30
Author(s):  
Paula McCauley
Keyword(s):  
United States ◽  
Health Care ◽  
Clinical Practice ◽  
Health Care Professionals ◽  
Bloodstream Infections ◽  
The United States ◽  
Evidence Based ◽  
Hospital Acquired Infections ◽  
Equity And Efficiency ◽  
Hospital Acquired

The growing concern for hospital-acquired infections in health care has stimulated the development of evidence-based practice (EBP) guidelines. Health care institutions across the United States are increas- ing their focus on the implementation of clinical practice guidelines using current EBP. Adherence to these guidelines by health care professionals is expected to improve the quality, equity, and efficiency of patient care.

scholarly journals Outpatient Cancer Care Delivery in the Context of E-Oncology: A French Perspective on “Cancer outside the Hospital Walls”

Cancers ◽  
2019 ◽  
Vol 11 (2) ◽  
pp. 219 ◽  
Author(s):  
François Bertucci ◽  
Anne-Gaëlle Le Corroller-Soriano ◽  
Audrey Monneur-Miramon ◽  
Jean-François Moulin ◽  
Sylvain Fluzin ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Care Delivery ◽  
Health Care Facilities ◽  
Point Of View ◽  
Care Providers ◽  
Public Authorities ◽  
Number Of Patients ◽  
Areas Of Interest

In oncology, the treatment of patients outside of hospitals has become imperative due to an increasing number of patients who are older and live longer, along with issues such as medical desertification, oncologist hyperspecialization, and difficulties in financing mounting health expenditures. Treatments have become less “invasive”, with greater precision and efficiency. Patients can therefore receive most of their care outside of hospitals. The development of e-health can address these new imperatives. In this letter, we describe the different e-health tools and their potential clinical impacts in oncology, as already reported at every level of care, including education, prevention, diagnosis, treatment, and monitoring. A few randomized studies have yet demonstrated the clinical benefit. We also comment on issues and limits of “cancer outside the hospital walls” from the point of view of patients, health care professionals, health facilities, and public authorities. Care providers in hospitals and communities will have to adapt to these changes within well-coordinated networks in order to better meet patient expectations regarding increasing education and personalizing management. Ultimately, controlled studies should aim to definitively demonstrate areas of interest, benefits, and incentives, for not only patients, but also caregivers (formal and informal) and health care providers, health care facilities, and the nation.

scholarly journals Inter-professional collaboration to improve outpatient attendance rates on a cochlear implant aural rehabilitation programme

2020 ◽  
pp. 201010582094889
Author(s):  
Kenneth Wei De Chua ◽  
Heng Wai Yuen
Keyword(s):  
Health Care ◽  
Cochlear Implant ◽  
Clinical Outcomes ◽  
Professional Education ◽  
Health Care Professionals ◽  
Professional Collaboration ◽  
Attendance Rates ◽  
Aural Rehabilitation ◽  
Number Of Patients ◽  
Before And After

Background: The cochlear implant (CI) programme at Changi General Hospital started in 2010. As the number of patients gradually increased over the years, a review of attendance rates from 2010 to 2016 showed that CI patients were not compliant in attending post-surgical aural rehabilitation sessions. A significant number of no-shows or appointment cancellations without rescheduling suggest that patients may not be motivated enough to go through aural rehabilitation. Hence, it was hard to evaluate clinical outcomes, which was demoralising for both the patient and health-care professionals involved. As transdisciplinary care is often involved in the aural rehabilitation process, we reviewed the existing CI clinical pathway to identify gaps in services, and with better fostering of inter-professional collaboration (IPC) in 2017, we compared the difference in outpatient aural rehabilitation attendance rates for patients seen before and after 2017. Methods: A retrospective review was undertaken of the outpatient administrative system to look at appointment cancellation rates before and after IPC for CI patients undergoing post-surgical aural rehabilitation from 2010 to 2019. A paired-sample t-test of significance was used, with the level of significance set at p=0.05. Problem analysis using the Problem, Intervention, Comparison, Outcomes framework helped in identifying the possible reasons for non-compliance with aural rehabilitation attendance. Inter-professional education among audiologists, otologists and speech therapists allowed for a close-knit IPC. Results: There were 78 patients with CIs from 2010 to 2019. Of these, 46 patients were implanted between 2010 and 2016, and 32 were implanted after IPC was introduced in 2017. The median cancellations rates were significantly reduced from 23% to 15%, with a p-value of 0.00. Days to switch-on and aural rehabilitation, number of appointment cancellations and total number of individual visits were significant independent predictors of the percentage of cancellations in regression analysis. Conclusion: Future studies are warranted to see if IPC can indirectly drive clinical outcomes, given that IPC encouraged better compliance with aural rehabilitation attendance post CI. It is imperative to have IPC in this dynamic health-care landscape with increasing complexities. IPC cannot be achieved without a close-knit relationship among the relevant health professionals.

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